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Journal ArticleDOI

Primary Care for Elderly People Why Do Doctors Find It So Hard

01 Dec 2002-Gerontologist (Oxford University Press)-Vol. 42, Iss: 6, pp 835-842
TL;DR: Much of the difficulty participants experienced could be facilitated by changes in the health care delivery system and in medical education, and the voices of these physicians and the model resulting from the analysis can inform change.
Abstract: Purpose: Many primary care physicians find caring for elderly patients difficult. The goal of this study was to develop a detailed understanding of why physicians find primary care with elderly patients difficult. Design and Methods: We conducted in-depth interviews with 20 primary care physicians. Using an iterative approach based on grounded theory techniques, a multidisciplinary team analyzed the content of the interviews and developed a conceptual model of the difficulty. Results: Three major domains of difficulty emerged: (i) medical complexity and chronicity, (ii) personal and interpersonal challenges, and (iii) administrative burden. The greatest challenge occurred when difficulty in more than one area was present. Contextual conditions, such as the practice environment and the physician’s training and personal values, shaped the experience of providing care and how difficult it seemed. Implications: Much of the difficulty participants experienced could be facilitated by changes in the health care delivery system and in medical education. The voices of these physicians and the model resulting from our analysis can inform such change.

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Journal ArticleDOI
TL;DR: Although there was some concern about sexism during medical encounters, in general, the women appeared to be less conscious of sexism than ageism.
Abstract: This study examines older women's views about and subjective experience of ageism during interactions with physicians. Views about and experience of sexism are also examined. Data were obtained from in-depth, face-to-face interviews conducted with 36 Canadian women 55 years and older. The findings indicate that older women believe ageism is likely to occur during medical encounters and are concerned about it. Few, however, claim to have personally experienced it. Contradicting the stereotype of the passive older patient, many participants were employing strategies to avoid becoming targets of ageism. Although there was some concern about sexism during medical encounters, in general, the women appeared to be less conscious of sexism than ageism.

14 citations

Journal ArticleDOI
TL;DR: The multidisciplinary team of case managers is central to the implementation of case management and helps case managers develop their new role and a core inter-professional competency.
Abstract: The case management process is now well defined, and teams of case managers have been implemented in integrated services delivery. However, little is known about the role played by the team of case managers and the value in having multidisciplinary case management teams. The objectives were to develop a fuller understanding of the role played by the case manager team and identify the value of inter-professional collaboration in multidisciplinary teams during the implementation of an innovative integrated service in France. We conducted a qualitative study with focus groups comprising 14 multidisciplinary teams for a total of 59 case managers, six months after their recruitment to the MAIA program (Maison Autonomie Integration Alzheimer). Most of the case managers saw themselves as being part of a team of case managers (91.5%). Case management teams help case managers develop a comprehensive understanding of the integration concept, meet the complex needs of elderly people and change their professional practices. Multidisciplinary case management teams add value by helping case managers move from theory to practice, by encouraging them develop a comprehensive clinical vision, and by initiating the interdisciplinary approach. The multidisciplinary team of case managers is central to the implementation of case management and helps case managers develop their new role and a core inter-professional competency.

13 citations

Journal ArticleDOI
TL;DR: Diffusion of collaborative care into the health care system and integrating geriatric psychiatry into other models such as geriatric medical homes will require redesign of the organization and financing of primary care and psychiatry to overcome current barriers.
Abstract: Health care services provided to older adults today are not as effective as they should be. The quality of care for late-life mental disorders often falls short of desired standards. The growth of the elderly population makes it imperative for the health care system to address late-life mental disorders more effectively. Intervention strategies based in primary care settings show the most promise, but effectiveness will depend on solving the geriatric psychiatry workforce crisis. Collaborative care is one promising model for improving geriatric mental health care delivery in primary care. Diffusion of collaborative care into the health care system and integrating geriatric psychiatry into other models such as geriatric medical homes will require redesign of the organization and financing of primary care and psychiatry to overcome current barriers. Public policy should reflect the essential role of psychiatry in geriatrics and promote the integration of geriatric psychiatry with primary care.

13 citations


Cites background from "Primary Care for Elderly People Why..."

  • ...The economics of primary care practice discourages primary care physicians from addressing geriatric mental health problems (Adams et al., 2002)....

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Journal ArticleDOI
TL;DR: Aging Couple Across the Curriculum allowed the interweaving of multiple issues that are characteristic of many geriatric cases and students were able to see the complexity of issues and the impact on other family members.
Abstract: Background: The medical students of today will deliver health care to an ever-increasing aging population. Regardless of specialties, physicians must view older patients holistically with attention to medical, psychosocial, and family issues and functional status. Description: This program was designed around a couple who ages from 60 to 90 over the 4 years of medical school. The woman represents the healthy aging process, whereas the man represents an elder experiencing multiple health problems. Through standardized patient experiences, small-group encounters, and paper-based learning modules, students address typical age-related issues that provide experiences representative of aging in today's society. Evaluation: Sessions were rated good to excellent. Comments were positive, especially regarding interactions with the aging couple. Conclusions: Aging Couple Across the Curriculum allowed the interweaving of multiple issues that are characteristic of many geriatric cases. Students were able to see the co...

12 citations


Cites background from "Primary Care for Elderly People Why..."

  • ...Teaching and Learning in Medicine, 18(3), 261–266 Copyright © 2006 by Lawrence Erlbaum Associates, Inc....

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25 Feb 2014
TL;DR: In this paper, the authors propose a 3.3-approximation algorithm for the 3.1-GHz bandit-16.3 GHz frequency bandit model, and
Abstract: 3

12 citations


Cites background from "Primary Care for Elderly People Why..."

  • ...It has been pointed out that the distinction between unstructured and semi structured is artificial, because no interview can be really considered unstructured, the focus of this paragraph is on the semi-structured, which are the main source of data for qualitative research (Adams et al., 2002)....

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References
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Journal ArticleDOI
TL;DR: The Nature of Qualitative Inquiry Theoretical Orientations Particularly Appropriate Qualitative Applications as mentioned in this paper, and Qualitative Interviewing: Qualitative Analysis and Interpretation Enhancing the quality and credibility of qualitative analysis and interpretation.
Abstract: PART ONE: CONCEPTUAL ISSUES IN THE USE OF QUALITATIVE METHODS The Nature of Qualitative Inquiry Strategic Themes in Qualitative Methods Variety in Qualitative Inquiry Theoretical Orientations Particularly Appropriate Qualitative Applications PART TWO: QUALITATIVE DESIGNS AND DATA COLLECTION Designing Qualitative Studies Fieldwork Strategies and Observation Methods Qualitative Interviewing PART THREE: ANALYSIS, INTERPRETATION, AND REPORTING Qualitative Analysis and Interpretation Enhancing the Quality and Credibility of Qualitative Analysis

31,305 citations

Journal ArticleDOI
TL;DR: In this article, the authors discuss the uses of literature and open coding techniques for enhancing theoretical sensitivity of theoretical studies, and give guidelines for judging a grounded theory study.
Abstract: Introduction Getting Started Theoretical Sensitivity The Uses of Literature Open Coding Techniques for Enhancing Theoretical Sensitivity Axial Coding Selective Coding Process The Conditional Matrix Theoretical Sampling Memos and Diagrams Writing Theses and Monographs, and Giving Talks about Your Research Criteria for Judging a Grounded Theory Study

28,999 citations

Journal Article
TL;DR: The Nature of Qualitative Inquiry Theoretical Orientations Particularly Appropriate Qualitative Applications as mentioned in this paper, and Qualitative Interviewing: Qualitative Analysis and Interpretation Enhancing the quality and credibility of qualitative analysis and interpretation.

22,714 citations

Journal ArticleDOI
TL;DR: The challenge is to organize these components into an integrated system of chronic illness care, which can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care.
Abstract: Usual medical care often fails to meet the needs of chronically ill patients, even in managed, integrated delivery systems. The medical literature suggests strategies to improve outcomes in these patients. Effective interventions tend to fall into one of five areas: the use of evidence-based, planned care; reorganization of practice systems and provider roles; improved patient self-management support; increased access to expertise; and greater availability of clinical information. The challenge is to organize these components into an integrated system of chronic illness care. Whether this can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care remains unanswered.

2,805 citations


"Primary Care for Elderly People Why..." refers background in this paper

  • ...In the area of practice organization, a number of interventions to facilitate primary care of chronically ill elders have been proposed and a few have been studied (Boult, Boult, Morishita, Smith, & Kane, 1998; Leveille et al., 1998; Schraeder, Shelton, & Sager, 2001; Netting & Williams, 2000; Wagner et al., 1996)....

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